Nursing Elites

1. A client with congestive heart failure taking digoxin reports nausea and refuses to eat breakfast. Which action should the nurse take first?

• A. Encourage the client to eat the toast on the breakfast tray.
• B. Administer an antiemetic.
• C. Inform the client's provider.
• D. Check the client's apical pulse.

Correct answer: D

Rationale: The correct action for the nurse to take first is to check the client's apical pulse. Nausea can be a sign of digoxin toxicity, and one of the early signs of digoxin toxicity is changes in the pulse rate. By checking the client's apical pulse, the nurse can assess if the digoxin level is too high. Encouraging the client to eat or administering an antiemetic may not address the underlying issue of digoxin toxicity. While informing the provider is important, assessing the client's condition through checking the apical pulse should be the immediate priority.

2. A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water (D5W) to infuse over 15 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the nurse set the manual IV infusion to deliver? (Round to the nearest whole number)

• A. 33 gtt/min
• B. 66 gtt/min
• C. 10 gtt/min
• D. 14 gtt/min

Correct answer: A

Rationale: To calculate the IV flow rate, you multiply the drop factor (10 gtt/mL) by the volume to be infused per minute (50 mL / 15 min). This gives you 10 gtt/mL × 50 mL / 15 min = 33.33. Rounding to the nearest whole number, the nurse should set the manual IV infusion to deliver 33 gtt/min. Choice B (66 gtt/min) is incorrect as it is the result of doubling the correct answer. Choice C (10 gtt/min) is incorrect as it only considers the drop factor without accounting for the volume to be infused. Choice D (14 gtt/min) is incorrect as it miscalculates the infusion rate based on the given information.

3. A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number)

• A. 20 mg
• B. 15 mg
• C. 10 mg
• D. 30 mg

Correct answer: A

Rationale: To calculate the dosage per dose, first, convert the toddler's weight from pounds to kilograms: 22 lb / 2.2 = 10 kg. Then, multiply the weight by the dosage: 4 mg × 10 kg = 40 mg/day. Since this total daily dose is divided into 2 equal doses, the nurse should administer 20 mg per dose. Therefore, the correct answer is 20 mg. Choice B (15 mg) is incorrect because it does not account for the correct weight conversion and dosage calculation. Choice C (10 mg) is incorrect as it only considers the weight conversion but doesn't multiply it by the dosage. Choice D (30 mg) is incorrect as it miscalculates the dosage by not dividing the total daily dose into 2 equal parts.

4. A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications?

• A. Methimazole
• B. Somatropin
• C. Levothyroxine
• D. Propylthiouracil

Correct answer: C

Rationale: Levothyroxine is the correct answer. In this scenario, the client's elevated TSH and decreased T3 and T4 levels indicate hypothyroidism, a condition where the thyroid gland does not produce enough hormones. Levothyroxine is a synthetic form of thyroid hormone that is used to replace or supplement the body's naturally produced thyroid hormones. Methimazole and Propylthiouracil are used to treat hyperthyroidism by reducing the production of thyroid hormones. Somatropin is a growth hormone used to treat growth hormone deficiency and other conditions unrelated to thyroid disorders.

5. A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take?

• A. Administer vitamin K
• B. Reduce the infusion rate
• C. Give the client a low-dose aspirin
• D. Request an INR

Correct answer: B

Rationale: An aPTT of 90 seconds is elevated, indicating a risk of bleeding due to excessive anticoagulation. The appropriate action is to reduce the infusion rate of heparin to prevent further complications. Administering vitamin K is not indicated for an elevated aPTT due to heparin therapy. Giving the client a low-dose aspirin can further increase the risk of bleeding when combined with heparin. Requesting an INR is not necessary for monitoring heparin therapy; aPTT is the more specific test for assessing heparin's therapeutic effect. Therefore, the correct action for the nurse to prepare to take is to reduce the infusion rate of heparin.

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